Question

Discuss the recommendations of JNC-7 and JNC-8, with regard to health outcomes and practice implications.

Answer 1

Two specific differences regarding treatment are as follows: JNC 7 recommended a treatment threshold of 140/90 mm Hg regardless of age, whereas JNC 8 raises the systolic threshold at age 60. ... β-blockers are no longer recommended for initial therapy because they might afford less protection against stroke.

In JNC‑8, the critical questions and review criteria were defined by an expert panel with input from the methodology team, followed by initial systematic review by methodologists restricted to RCT evidence.6Subsequent review of RCT evidence and recommendations were made by the panel according to the standard protocol.

.In JNC‑8, the critical questions and review criteria were defined by an expert panel with input from the methodology team, followed by initial systematic review by methodologists restricted to RCT evidence.Subsequent review of RCT evidence and recommendations were made by the panel according to the standard protocol.In JNC‑7, methodology was based on nonsystematic literature review by an expert committee including a range of study designs, and recommendations were made based on consensus.

.review of RCT evidence and recommendations were made by the panel according to the standard protocol.In JNC‑7, methodology was based on nonsystematic literature review by an expert committee including a range of study designs, and recommendations were made based on consensus.This change is said to be an improvement on the previous process of the past JNCs.

The 7th Joint National Committee (JNC7) defined hypertension as a systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg, regardless of age. Blood pressure was divided into the following categories: Normal: SBP < 120 and DBP < 80, Prehypertension: SBP 120-139 or DBP 80-89, Stage 1 hypertension: SBP 140-159 or DBP 90-99, and Stage 2 hypertension: SBP > 160 or DBP ≥ 100 [8,9]. At the end of 2017, the American Heart Association/American College of Cardiology (AHA/ACC) released new guidelines lowering the threshold to define elevated blood pressure.

Worldwide cardiovascular disease accounts for approximately 17 million deaths a year of which, complications of hypertension account for 9.4 million deaths worldwide [3]. WHO data says by 2025 the global burden of hypertension will increase by 60% worldwide with higher in developing countries [4]. Developing countries specifically presents with higher incidence of undiagnosed, untreated and uncontrolled hypertension attributed to poor health system which may be because of population growth, ageing, behavioral risk factors, unhealthy food habits, lack of exercise and increase exposure to persistent stress